Provider Demographics
NPI:1770785263
Name:GATEWAY PHYSICAL THERAPY AND WELLNESS PC
Entity type:Organization
Organization Name:GATEWAY PHYSICAL THERAPY AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-2493
Mailing Address - Street 1:1211 S RESERVE ST
Mailing Address - Street 2:SUITE 202E
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3101
Mailing Address - Country:US
Mailing Address - Phone:406-728-2473
Mailing Address - Fax:406-542-6393
Practice Address - Street 1:1211 S RESERVE ST
Practice Address - Street 2:SUITE 202E
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3101
Practice Address - Country:US
Practice Address - Phone:406-728-2473
Practice Address - Fax:406-542-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1515MT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00600030Medicaid